Azzam Alkhalifah

Lichen planus (LP) is a long-lasting inflammatory skin disorder that is caused by an immune response and leads to a continuous state of inflammation. The condition is distinguished by the existence...

The increasing prevalence of hair loss, particularly among men, has led to a growing interest in natural remedies. Among these, Rosmarinus officinalis leaf extract (rosemary) has gained attention for its potential hair growth-promoting properties. This review examines the efficacy of some natural remedies, with a focus on rosemary extract, in stimulating hair growth in patients with androgenetic alopecia (AGA). In contrast to conventional treatments like minoxidil and other chemical remedies, which often come with undesirable side effects such as scalp irritation, systemic effects, and potential dependency, rosemary offers a more natural alternative with fewer adverse effects. Using both in vitro and in vivo models, the research assesses the extract’s efficacy in enhancing hair follicle proliferation and extending the anagen phase of hair growth. Clinical trials demonstrated significant improvements in hair density and thickness among participants using rosemary extract compared to control groups. These findings suggest R. officinalis leaf extract may serve as a viable natural alternative for hair loss treatment, warranting further investigation into its mechanisms and long-term benefits. This review highlights the need for further research into natural remedies, as well as rosemary’s long-term efficacy and safety, positioning it as a promising candidate for those seeking a safer approach to hair restoration.

Introduction: Although glucagon-like peptide-1 receptor agonists (GLP-1 RAs) demonstrate remarkable efficacy for weight management, emerging pharmacovigilance data suggest an increased hair loss risk, particularly with newer agents. This study investigated the prevalence, risk factors, and clinical impact of hair shedding in GLP-1 RA users in Saudi Arabia. Methods: A cross-sectional survey was conducted between September 2024 and January 2025 of current and former GLP-1 RA users. Participants with preexisting hair loss were excluded from the study. Hair shedding prevalence, associated factors, and the impact on treatment discontinuation were assessed using validated questionnaires. Multivariate logistic regression was used to identify independent predictors. Results: Among 152 eligible participants (87.5% female, median body mass index 32.1 kg/m2), 70.4% (n = 107) reported hair shedding after GLP-1 RA initiation, which was markedly higher than the 3–7% reported in clinical trials. Tirzepatide users had the highest prevalence (76.7%), followed by semaglutide (64%) and liraglutide (54.5%). Hair shedding was significantly associated with female sex (92.5% vs. 75.6% in males, p = 0.009), greater magnitude of weight loss (82.7% prevalence with ≥15% weight loss vs. 40% with <5%, p = 0.002), and medication discontinuation (63.6% vs. 40% in non-shedders, p = 0.013). Multivariable analysis confirmed independent associations with increasing weight loss (OR 1.79, 95% CI: 1.19–2.76, p = 0.006) and female sex (OR 3.57, 95% CI: 1.20–11.11, p = 0.023). Critically, 39.7% of the affected patients cited hair shedding as their reason for discontinuation, although 37.7% reported resolution after stopping treatment. The median weight loss was 15.9% [IQR 8.69–22.5], with 53.3% achieving ≥15% reduction. Conclusion: Hair shedding affects seven out of ten GLP-1 RA users in real-world settings, representing a ten-fold higher prevalence than that reported in registration trials. This under-recognized phenomenon during GLP-1 RA therapy significantly affects treatment adherence, particularly among women who achieve substantial weight loss. Proactive counseling and nutritional optimization strategies are essential to maintain treatment persistence.

Introduction: Herbal medicine is a medical system based on the utilization of plants or plant extracts for therapy. The continual increase in global consumption and the trade of herbal medicine has raised safety concerns in many regions. These concerns are mainly linked to microbial contamination, which could spread infections with multi-resistant bacteria in the community, and heavy metal contamination that may lead to cancers or internal organs’ toxicity. Methods: This study was performed using an experimental design. A total of 47 samples, herbal medicine products sold in local stores in Qassim region, were used in the experiments. They were tested for bacterial contamination, alongside 32 samples for heavy metal analysis. Bacterial contamination was determined by the streak plate method and further processed to determine their antimicrobial susceptibility patterns using MicroScan WalkAway96 pulse; heavy metals were determined using a spectrometer instrument. Results: A total of 58 microorganisms were isolated. All samples were found to be contaminated with at least one organism except three samples. The majority of the isolated bacterial species were gram negative bacteria, such as Klebsiella spp., Pseudomonas spp. and E. coli., which could be of fecal origin and may lead to pneumonia, skin, or internal infections. Furthermore, most of the gram-positive bacteria were found to be multi-drug resistant. Moreover, for heavy metals, all samples had levels exceeding the regulatory limits. Conclusion: This study demonstrated the presence of bacteria and heavy metals in samples of herbal medicines. Using these contaminated products may spread resistant infections, metal toxicities, or even cancers in the community.

Introduction: Over the last few decades, use of complementary and alternative medicine (CAM) has grown in popularity, changing health professionals’ knowledge and attitude toward CAM, and the treatment recommended by them. The aim of the study was to evaluate the perception and practice of CAM among healthcare professionals. Methodology: A cross-sectional study was conducted among healthcare providers selected by multistage random sampling technique in two governmental hospitals and ten primary healthcare centers in two governorates in the Qassim region, Saudi Arabia. A web-based, self-administered questionnaire was distributed via social media platforms. Results: A total of 350 physicians responded to the survey. Good basic knowledge about CAM was reported by 48.6% of the respondents; a positive attitude was adopted by 53%; and CAM was actively practiced by 9.7%. Being a physician > 40 years and consultant affiliation were significantly associated with higher knowledge level about CAM (p = 0.006 and 0.03, respectively), as well as having a proactive practice (p = 0.007 and 0.04, respectively). Practicing CAM was prevalent among non-Saudi and married physicians (p = 0.02 for both). Knowledge about CAM and its practice were strongly correlated (p = 0.007). The most frequent constraints facing CAM practice were lack of knowledge and training on CAM (81.4%) and lack of studies supporting CAM (74.3%). Conclusions: The practices of health professionals in Qassim region need to be improved despite their expertise and favourable perception of CAM. Educational interventions could play greater roles in providing evidence-based CAM knowledge and enhancing training for physicians.

Introduction: Herbal medicine is a medical system based on the utilization of plants or plant extracts for therapy. The continual increase in global consumption and the trade of herbal medicine has raised safety concerns in many regions. These concerns are mainly linked to microbial and heavy metal contamination. Methods: This study was performed using an experimental design. A total of 47 samples were used in the experiments, which were tested for bacterial contamination, alongside 32 samples for heavy metal analysis. Bacterial contamination was determined by the streak plate method and further processed to determine their antimicrobial susceptibility patterns using MicroScan WalkAway96 pulse; heavy metals were determined using a spectrometer instrument. Results: A total of 58 microorganisms were isolated. All samples were found to be contaminated with at least one organism except one sample. The majority of the isolated bacterial species were gram negative bacteria, such as Klebsiella spp., Pseudomonas spp. and E. coli. Furthermore, most of the gram-positive bacteria were found to be multi-drug resistant. Moreover, for heavy metals, all samples had levels exceeding the regulatory limits. Conclusion: This study demonstrated the presence of bacteria and heavy metals in samples of herbal medicines. These findings suggest the potential risks for those patients who use herbal medicine.

Background: Skin is the largest and the outermost body organ. It is directly affected by the external environment. The biomechanical differences in wheelchair users compared to healthy people make them prone to different risk factors of skin problems. Nevertheless, these patients are under-represented in the dermatologic literature. Objective: The primary objective was to determine the frequency of different skin problems among wheelchair users. The secondary objective is to determine the different precautions they are taking to prevent these problems. Methods: The prospective study followed a cross-sectional design, conducted during the period of the coronavirus disease 2019 curfew between May and June 2020. The survey’s link was distributed among adult wheelchair users in Saudi Arabia. The questionnaire was administered using google forms. All statistical analyses were performed using SPSS version 22. Results: The results show that the vast majority of wheelchair users (85%) experienced skin problems. Pressure ulcer (PU) is the most frequently reported skin condition (54%), followed by traumatic wounds, fungal infections, and hand skin dryness and thickening. The commonest preventive measure was using cushions to avoid PUs. Conclusion: Most of wheelchair users reported having a history of skin complaints, of which PU was the most common followed by traumatic wounds and fungal infections. Thus, spreading awareness of the risk factors and preventive methods would help them avoid its development and prevent its negative impact on quality of life. Assessing the different kinds of wheelchairs and cushions to avoid PUs would be an interesting area for future studies.

BACKGROUND: Treating infraorbital dark circles is one of the commonest aesthetic demands worldwide. Autologous fat transfer is commonly used to treat dark circles by filling the grooves, without effect on skin quality. Platelet-rich plasma has been reported to improve skin quality. Autologous fat can be emulsified and filtered to produce nanofat, which is then injected superficially in the dark circles to improve skin quality and discoloration. OBJECTIVE: To compare the efficacy of platelet-rich plasma versus combined fat transfer and nanofat in treating infraorbital dark circles. MATERIALS AND METHODS: 30 patients with infraorbital dark circles of combined etiological factors were randomized into 2 equal groups: Group A treated with platelet-rich plasma and Group B treated with autologous fat transfer with emulsified fat injection. RESULTS: Excellent and moderate responses were observed in 3 (20%) and 2 (13%) patients in group A versus 7 (46.7%) and 4 (27%) in group B, respectively. Nonresponders were 8 (53.3%) in group A and only 1 patient (6.7%) in group B. The difference was statistically significant regarding improvement (p = .048) and patient satisfaction (p = .032). CONCLUSION: Autologous fat transfer with nanofat is significantly superior to platelet-rich plasma in improvement and satisfaction.

Vitiligo is one of the disorders where we usually see Koebner lesions. Lasers target a chromophore in the skin to deliver their energy. Their effect is theoretically considered as injury and may induce Koebner lesions in vitiligo patients. Few cases were reported with the different kinds of laser, including laser hair removal (LHR). No cases have ever been reported of vitiligo lesions induced by Alexandrite LHR. Here we present a case report of a young female patient who had never had vitiligo until she received a 755-nm LHR treatment. These vitiligo lesions were completely treated with NB-UVB with no recurrence until 4 years later when she received another 755-nm LHR treatment session with a different machine, which lead to new vitiligo patches only on the areas that received the laser.